The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Sunday, March 07, 2010

Democratic divides on health care keep multiplying

House Democratic leaders pledge to hold a vote on health care by their Easter break, which gives lawmakers about three weeks to resolve dozens of disagreements that stand in the way of passing legislation. "There is all kinds of stuff in the ether," Rep. Anthony Weiner, D-N.Y., said, referring to the long list of differences Democrats have over how to write the health care bill.

Democrats plan to have the House vote on a Senate-passed version of the plan and then make corrections in a smaller bill that would have to be approved by both chambers. Democrats so far can't agree on what would go in the smaller bill and there may not be enough support among House Democrats to pass the Senate bill in the first place.

House Speaker Nancy Pelosi said she will convince members of her caucus to vote for the bill, but conceded she is unable to persuade members yet because there is no proposal in writing and no accompanying price tag for it. "When I talk to my members, I have to have two important pieces of information," Pelosi said. "One is, what is the final status of the bill? And two, what is the Senate going to do about it? What are the actions the Senate is going to take? The Senate cannot tell us that until they see the final product as well."

Senate leaders said they are at the mercy of the Congressional Budget Office, which is responsible for scoring any new proposal. But there is no proposal yet, because Democrats cannot agree on a final product.

Despite House Majority Leader Steny Hoyer's pledge for a pre-Easter vote, even he said on Thursday there is still a lot to work out first. "You have to resolve this in a way that gives a comfort level to both sides," Hoyer told The Examiner, referring to differences between the House and Senate. The comfort level, he said, "is missing over here."

While Senate and House Democratic leaders met in the Capitol to hash out a compromise, President Obama continued to play referee at the White House, inviting the liberal and moderate Democratic factions of the House to separate meetings. On attendee was Ron Kind, D-Wis., who said he and many other moderates want the health care plan to do more to rein in costs and improve Medicare. The Senate bill, he said, "seems inadequate."

Liberals like Weiner actually want to spend more on reform, saying that in the end it will save more money. "Some of the problems can be easily fixed if the president loses his love affair with a specific number for the bill," Weiner said, referring to the $900 billion spending limit Obama has publicly put on the legislation.

But it may be harder to resolve other, smaller problems that could create big headaches for the leadership, such as the desire by the Hispanic caucus to include Puerto Rico in the health care reform plan. "There are a lot of people who feel they have been taken for granted here," Weiner said. "It doesn't take much to create a firestorm."

Mr. Obama is loath to say the word "reconciliation," because he knows "reconciliation" is this season's synonym for suicide. So he warns of the danger of flip-floppery. His health care "reform" passed the House by only five votes, and deaths and resignations have reduced the margin. There's no margin left for flip-floppery. That's the message the president's desperate lobbyists are taking to Capitol Hill. He wants a vote before Congress departs for its Easter vacation at the end of the month, and promises his loyalists that he will apply enough flim-flammery over the next fortnight to discourage flip-floppery.

The president's men remind wavering congressmen of Sen. John Kerry's boast that he voted for the second war in Iraq before he voted against it, and everyone knows how that turned out. They could draw a lesson from Bill Clinton as well, who once tried to explain away his support for sending troops to the first Gulf War as a straddle: "I was for it but I was really for those who were against it."

This time, Mr. Obama wants an up-or-down vote, and no straddling. But unless there's an irresistible congressional impulse for suicide, the White House has a tough sell, and the president knows it. "The American people want to know if it's still possible for Washington to look out for their interests and their future," he says. "I don't know how this plays politically, but I know it's right."

That's not quite what the American people want to know, and besides, it's a weak appeal to a frightened congressman. It sounds like the beginning of a concession speech. A congressman, like a president, is always calculating the politics. Doing the right thing is OK, unless you overdo it and certainly not if it ends a career. Mr. Obama has been in Washington long enough to recognize the difference between community organizing, which is about stirring up trouble, and congressional politics, which is first about getting re-elected.

The president and his party loyalists have been forced into a defensive game. They can't afford to lose a single vote, and the temper of the times encourages flip-floppery. Retreating from an earlier vote to enact Obamacare to a new vote to kill Mr. Obama's poisonous "reform" is merely a desperate attempt at survival. The Republicans and the Democratic Blue Dogs who are riding the crest of sentiment against Obamacare will hardly be tempted to change their votes.

After months of tea parties, presidential threats, pleading harangues and enough hot air to melt the polar bears there's not anything left to say, but certain embattled Democratic incumbents are trying to hide behind words. Sen. Blanche Lincoln of Arkansas, the most seriously threatened Democratic incumbent, is in trouble at home for her vote for the Senate bill. She can't explain it away, since it's on the record, but now she vows she will vote against "reconciliation." She doesn't say how she will vote when "reconciliation" by another name is used to silence Senate dissent. Sen. Mitch McConnell of Kentucky, the leader of the Republican minority, promises that the Republicans will make "every election in America this fall a referendum on this issue."

The latest obstacle in the president's way is the vow of Rep. Bart Stupak of Michigan to destroy the legislation unless stronger language to prevent subsidization of abortion is written into the Senate bill. He says he has 10 House colleagues with him. The abortionistas in the House insist they won't vote for the Senate bill if the president caves.

Nancy Pelosi, the speaker and leader of the San Francisco Democrats, says her members "are very excited about what comes next." For many of them, that's "excited" as in "hysterical." If White House pressure prevails and Mr. Obama wins the vote, the campaign of 2012 begins at once with a Republican promise to repeal the monstrosity. That's when the real fun begins.

President Barack Obama's obsessive, opportunistic demonization of insurance companies in his quest to pass his not-yet-written health care proposal is growing tiresome. Aren't you getting sick of a president attacking American citizens and businesses as if they -- not Obama's beloved government -- were the enemy? His repeated implication that insurance companies are the primary reason for rising health care costs is politically expedient, but it's still untrue. Government is the main culprit.

Throughout his yearlong push for Obamacare, he has called insurance companies every name in the book. He has blamed them for soaring costs, bludgeoned them for taking profits, condemned their executives' salaries and savaged them for denying coverage for pre-existing conditions. He even says insurers are the final arbiters of who gets care and who doesn't: "And insurance companies freely ration health care based on who's sick and who's healthy, who can pay and who can't."

Obama has framed the entire debate as if it were an insurance problem. In his theatrical speech Wednesday -- while flanked from all sides by white-coated props -- he said, "We began our push to reform health insurance last March," as if the thrust of his health care efforts has been to rein in insurers and little else.

Though Obama surely hates insurance companies, we all know he is up to much more than just punishing them. This is about a government takeover, even if it takes several incremental steps. Vilifying insurers sells better than glorifying government to a center-right nation generally suspicious of government.

Insurance companies are not the main reason for our exploding health care costs. If they were, the solution would not be to increase regulations on them, but to deregulate them and let the market work its magic. To blame insurers for increasing costs is to imply they are guilty of some kind of collusion or price fixing. Does Obama really believe we have an evil insurance cartel in America?

Could it be that their rates are symptomatic of higher health care costs rather than the main driver of those costs? That said, aren't we likelier to see more competitive rates if we relax onerous regulations, such as laws preventing the purchase of health insurance across state lines (one of the many Republican proposals)?

It's very clever -- and reminiscent of his street-agitating mentor Saul Alinsky -- for Obama to adopt the anti-government language of conservatives to use against insurance companies. They are "rationing" care, he says. No, they enter into contracts with individuals and groups to provide insurance coverage as defined in the contract. They don't arbitrarily deny coverage if they have contractually agreed to provide it. But if they do, legal remedies are available.

I realize Obama has no qualms about violating the contracts clause of the Constitution and interfering with private contracts, but that's not the way it's supposed to work in America. For him to suggest that insurers must be forced to cover pre-existing conditions is tantamount to saying the government is going to convert them from insurance companies to unconditional guarantors. How can you call it insurance if you remove their ability to calculate their own risk assessments? If, in his dictatorial omniscience, Obama tells insurance companies what they must cover, how many of them will remain in business while forced to take losing deals -- absent government subsidies?

Even if you believe insurers are culpable, you will still be hard-pressed to demonstrate that any insurance pricing abuses are responsible for more than a fractional percentage of our rising health care costs. Republicans made that point quite cogently during Obama's bogus summit, and he didn't even pretend to have an answer for it.

I believe our rising costs are attributable mostly to government interference with free market forces. The price mechanism is not allowed to work because, due to tax laws, most people get their insurance through their employers and don't have to pay out of pocket for their own insurance and so the costs are invisible to them. They don't base their consumption on what they can reasonably afford.

In addition, the government has mucked things up with Medicare and Medicaid, mandates insurance coverage for unnecessary procedures, prevents interstate insurance purchases, as noted, and obstructs health savings account reforms and tort reform.

By demonizing insurers, Obama is diverting attention from the real villain here -- an intrusive federal government -- so he can give it even more control. The people know better, which is why he's endorsing legislative shenanigans to get it done, despite condemning that approach in the recent past.

Oh, yes, and if you believe he's going to rein in government costs and "fraud and abuse," there's some real estate I'd like to sell you at a fictitious address with a phantom ZIP code.

Under Obamacare, fewer people will choose to make a career of medicine, which will cause untold ripple effects

In Britain the result has been that the government has to pay very high salaries to get doctors into its government hospitals -- and even then a large proportion of its doctors and nurses are poorly-trained third-world imports

I have rarely been as troubled as I was when I read a Facebook conversation, probably 8 months ago now, about socialized medicine. One of the participants opined that it probably wouldn’t be a bad idea to downplay the profit motive in the health care industry. You might assert that such an ivory towered notion could only emerge from the hallowed halls of academia and sadly, you would be right in this instance.

Our family doctor’s HMO already is refusing to take many patients with Anthem/Blue Cross/Blue Shields insurance because Anthem will only pay the Medicare baseline. (He consented to continue accepting us as patients in spite of our Anthem coverage, because of our relationship with him, which now spans a good number of years.) What will transpire when insurance companies go out of business because they can’t compete with government undercutting their prices under all of the enhanced powers government accrues as the price negotiator of first resort? Or alternatively, when more insurance companies begin to adopt Anthem’s tactics?

The profit incentive is central to the human condition. People excel when there is accomplishment for which to strive. Such achievement is codified in the possession of private property, of which money in the bank account is a key component. This is not to say that motivated workers cannot also be charitable. America’s record of voluntary local giving and worldwide monetary assistance is second to none, as all statistics show. But can anyone truly give from the heart if the donation is not voluntarily rendered? Indeed, is it not, in the end, forceful taxation if the dollars that are forfeited are done so on other than a wholeheartedly willing basis?

Why should doctors be any different, simply because they practice healing the sick? Most medical professionals, after all, spend around 10 years of their lives in arduous and expensive academic programs before they earn their first penny. What fool will continue to do this if not assured a comfortable income and standard of living upon graduation that will remunerate all of the costs absorbed in transit? (I’m fairly sure that the academic I observed making the comment about the “profit motive in healthcare” makes a high 5-figure salary, with a lush package of perks and didn’t have to go to an Ivy League-level school to obtain his/her current job.)

If fewer doctors practice medicine, costs will not only rise (and don’t kid yourself; they will), but treatment will have to be rationed. And yes, call it what you will, but death panels will result. Does anyone really believe that if the government is financing health care for an increasing percentage of the population, with a finite money supply, it will not decide what will be paid for and who will reap the benefits? It is simple economics: Tinker with the supply curve of anything and demand is always impacted.

(This reminds me of a discussion I had with an economist a couple of years ago when I expressed bewilderment at the inability of many politicians to grasp basic economic concepts. His reply? “Look at the industry most of them come from. The vast majority are attorneys.”)

If the President, Harry Reid and Nancy Pelosi really wanted to reform health care, they would implement measures that would increase competition on every conceivable front. Malpractice lawsuit reform and freedom to purchase insurance across state lines are great places to start.

But if this were really about reform, the President would have listened to the ever-growing majority by now and either forged a legitimate consensus of some kind or started over. With statists like Barack Obama, it is always about further government control, a far more apt description that the chameleonic term “reform” which can be imbued with any meaning with which the user determines to endow it.

One final question: If (pray God, it is so!) this monstrosity of a bill does not pass, how soon will we forget, in our bleary fatigue, that we have waged this fight and that we must continue to explain, with clarity and detail, to the next generation why we did it? One hopes that the residual memory lingers. Unfortunately, the lesson of history teaches that the reality should rather lead us to expect otherwise.

Neglected by 'lazy' British nurses, man, 22, dying of thirst rang the police to beg for water

A man of 22 died in agony of dehydration after three days in a leading teaching hospital. Kane Gorny was so desperate for a drink that he rang police to beg for their help. They arrived on the ward only to be told by doctors that everything was under control.

The next day his mother Rita Cronin found him delirious and he died within hours. She said nurses had failed to give him vital drugs which controlled fluid levels in his body. 'He was totally dependent on the nurses to help him and they totally betrayed him.'

A coroner has such grave concerns about the case that it has been referred to police. Sources say they are investigating the possibility of a corporate manslaughter charge against St George's Hospital in Tooting, South London.

Mr Gorny, from Balham, worked for Waitrose and had been a keen footballer and runner until he was diagnosed with a brain tumour the year before his death. The medication he took caused his bones to weaken and he was admitted to St George's for a hip replacement in May last year. The operation left him immobile and unable to get out of bed. His 50-year-old mother says that he needed to take drugs three times a day to regulate his hormones. Doctors had told him that without the drugs he would die.

Although he had stressed to staff how important his medication was, she said, no one gave him the drugs. She said that two days after his hip operation, while Miss Cronin was at work, he became severely dehydrated but his requests for water were refused. He became aggressive and nurses called in security guards to restrain him. After they had left, he rang the police from his bed to demand their help.

Miss Cronin, who is divorced from her son's father Peter, said: 'The police told me he'd said, "Please help me. All I want is a drink and no one is helping me". 'By this time my son was confused due to his lack of medication and I think the nurses just ignored him because they thought he was just being badly behaved. 'They were lazy, careless and hadn't bothered to check his charts and see his medication was essential.'

That evening, Miss Cronin visited him. She said: 'I told Kane to behave himself because I thought he had been causing trouble - and I feel so bad about that now. I thought maybe he was having a bad reaction to the morphine he was on but in fact it was because he had not had his medication.' The next morning she visited him before going to work. 'He was delirious and his mouth was open,' she said. 'I gave him a drink of Ribena.

'I told three nurses there was something wrong with my son and they said, "He's fine" and walked off. I started to cry and a locum doctor who was there told me not to worry. 'Eventually the ward doctor came round, took one look at Kane and started shouting for help.'

Miss Cronin was asked to leave her son's bedside. 'He died an hour later,' she said. 'I didn't even realise he was dying. I didn't even have a chance to say goodbye.'

The death certificate said Mr Gorny had died because of a 'water deficit' and 'hypernatraemia' - a medical term for dehydration [Rubbish! It means too much salt. But it probably is a misprint for hyponatremia -- lack of salt]. His mother added: 'When I went back to the hospital I was told that all the nurses had been offered counselling as they were so traumatised, but nothing was offered to me. 'The whole thing is a disgrace. This hospital has a brilliant reputation and boasts of its excellent standards and safety record. 'But as soon as my son walked into that ward, his death warrant was signed. Of the 32 people who were involved in my son's care, every one made a mistake that ultimately led to his death, from the consultant to the care assistant.

'There has been an internal investigation but St George's never made it public and it was a whitewash- After his death the hospital never phoned me or wrote to me to apologise. How could this happen in the 21st century?'

A Metropolitan Police spokesman said: 'Detectives from the Homicide and Serious Crime Command are investigating the death of Kane Gorny at St George's Hospital after this was referred to us by Westminster Coroner's Court.'

A spokesman for St George's Hospital said: 'We are extremely sorry about the death of Kane Gorny and understand the distress that this has caused to his family. 'A full investigation was carried out and new procedures introduced to ensure that such a case cannot happen in future. [Ho, ho!] 'We have written to the family to explain the actions that have been taken and to answer their concerns about Mr Gorny's care. The family has also been invited to meet with trust staff to discuss the case in detail.'

The tragedy emerged a week after a report into hundreds of deaths at Stafford Hospital revealed the appalling quality of care given by many of the nurses. This week a task force called on nurses to sign a public pledge that they will treat everyone with compassion and dignity.

Plans that could lead to the closure of hundreds of hospital wards are being drawn up but will not be made public until after the general election, opposition parties have said.

Last year, the Government asked NHS authorities to come up with proposals to reorganise the service to save money as a result of the recession. Details have started to emerge of what is likely to be a rolling programme of cuts that contrasts sharply with assurances from Labour and the Tories that the NHS was “safe”. So far, only the plans for London have come to light. Campaigners claimed the proposals threatened services such as casualty and maternity units at 13 out of 36 hospitals in the capital.

The failure of health authorities in other areas to disclose their response has prompted allegations that proposed closures, which could be politically damaging to the Government, will not be published until after polling day.

The scale of the cuts has caused a rebellion among Labour ministers who have openly defied the Government by publicly protesting at closures at their local hospitals.

Next week, health ministers will come under pressure from the Conservatives and Liberal Democrats to disclose the scale of the plans, with the Tories calling an emergency debate on the issue. Norman Lamb, the Liberal Democrats’ shadow health spokesman, said the scale of the cuts to hospitals was likely to be “vast”, with potentially “hundreds” of wards closing. He said: “The Government will be desperate to avoid these cuts ahead of an election. We could end up with the threat of cuts to services being a key issue in the election campaign. The electorate will feel conned if they come out after the campaign. “It is hard to judge the scale of this but it could be vast. It could be hundreds [of wards]. The savings they have to achieve are enormous. What has emerged in London could be the tip of the iceberg and the public is unaware of the scale of potential cuts.”

Mike Penning, the Tory shadow minister for health in London, said: “I see no reason why these reports cannot be published before the election. Labour must be straight with people about the cuts that they are planning to make to their local NHS.”

The cutbacks are partly as a result of Lord Darzi’s 2008 review of the NHS, which recommended more community based treatment in large GP centres and bigger, specialist treatment centres in hospitals. Authorities were asked by the Department of Health to draw up plans to implement Lord Darzi’s review. But last year, they were told to reconsider their proposals after the recession.

Opposition parties have claimed that health authorities were considering closing or merging key hospital departments, many of which have received millions of pounds in investment in recent years.

The NHS is coming under pressure to find other savings despite government claims that the health service would be protected from widespread public spending cuts. In this month’s budget, Alistair Darling, the Chancellor, is expected to announce that the NHS will have to find savings of up to £10 billion a year. Liam Byrne, a Treasury minister, said last month that hospital buildings were likely to be mothballed as services were moved to community based health centres. Dr John Lister, the author of the British Medical Association’s recent report on the plans, described the scale of the cuts being proposed as “a disaster”.

Threatened hospital closures are likely to become one of the key election issues. Labour ministers and MPs faced claims of hypocrisy after starting pre-election campaigns to block closures at their local hospitals. Ministers were pictured protesting against closures and writing to residents setting out their opposition. Many fear they will lose their seats if they are seen to back government policy.

Last weekend, David Lammy, the Higher Education minister, was joined by other local Labour MPs when he led a march to “save” the Whittington Hospital casualty department in north London. The Whittington also faces cuts to maternity services, although £600,000 of public money was recently spent on its new birth centre. Other high-profile Labour MPs campaigning to protect hospitals in their constituencies include Margaret Hodge, the Culture and Tourism Minister who represents the marginal seat of Barking. She has led a campaign to save the Accident and Emergency unit at King George Hospital in Ilford.

Mike Gapes, the Labour MP for Ilford South, also backs the campaign. “I will fight a Labour government, a Conservative government or a Martian government to keep a hospital in my constituency,” he said yesterday.

Last night, Andrew Lansley, the shadow health secretary, said: “Labour MPs are campaigning on a general election manifesto which would lead to the first cuts to the NHS budget for years, but yet they still try to portray themselves as local champions by protesting against cuts in their own backyards.”

A department spokesman said any discussion of the scale of cuts was “speculation”. The local NHS plans would be published after the budget, she said. “These are tough times and we are committed to continuous improvement in efficiency. The NHS locally is best placed to identify savings based on their circumstances and priorities.”

1 comment:

Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here